Effect of Yoga-based Interventions on Heart Rate Variability and Anxiety Among Students: A Systematic Review and Meta-analysis

Abstract

Background

Previous studies have shown improvement in anxiety and cardiac parameters among university students. However, no systematic review and meta-analysis have examined the effect of yoga-based interventions on heart rate variability (HRV) and anxiety among students.

Purpose

To synthesise the evidence regarding the effects of yoga-based intervention on improving HRV and anxiety among students.

Methods

A systematic search was conducted in accordance with PRISMA 2020 guidelines in PubMed, Scopus, Cochrane Library, and Web of Science for randomised controlled trials (RCTs) that assessed the effects of yoga on anxiety and HRV up to March 2025. We included the RCTs that assess both HRV and subjective measures of anxiety in the student population. The quality of the included studies was evaluated by the Cochrane ‘risk of bias’ tool (version 2019). Meta-analyses were conducted using RevMan software.

Results

The search identified 255 studies, out of which five studies met the inclusion criteria. Four studies were included in the meta-analysis, which show a positive impact of yoga on anxiety and HRV measures among the students.

Conclusion

Yoga reduces anxiety and improves HRV among the students. Further rigorous studies are needed to identify the optimal characteristics of yoga for the students.

Keywords

Mental health yoga academics anxiety heart rate variability

Introduction

Anxiety is one of the most common mental health issues among the student community across the world. An umbrella review study on 25 studies has reported anxiety prevalence to be approximately 32% (varying between 7.5% and 55%) among college students experiencing anxiety.¹ A systematic review of 89 studies reported a prevalence of 39.65% for non-specific anxiety in undergraduate university students, with 49.94% exhibiting mild anxiety, 35.64% showing moderate anxiety, and 20.31% experiencing severe anxiety.²

The most common sources of anxiety are academic pressure, financial concerns, and future uncertainties. Other stressors from their day-to-day life, such as parental expectations, cultural or language differences among peers, assignment burdens, intense examination pressure, etc.³ Anxiety is a serious concern as it significantly affects academic performance and overall well-being. It also impacts the motivation, various cognitive abilities such as attention, memory and concentration, leading to poor academic performance. Anxiety affects various psychological measures such as self-esteem, mood, confidence and communication skills, which are crucial for academic success.⁴

Due to these challenges, students are unable to perform well academically, manage their personal lives, or achieve their long-term career goals later in life.⁵

Anxiety has a significant negative impact on various physiological functions, including the autonomic nervous system. Chronic anxiety contributes to autonomic dysfunction by increasing sympathetic dominance and reducing vagal tone, which is evident through a decrease in heart rate variability (HRV).^{6, 7} Anxiety induces more attention to threats than usual.⁸ This chronic threat detection can increase the activation of the Sympathetic nervous system, resulting in chronic withdrawal of the parasympathetic activity, which leads to long-term reduction in HRV.⁹ Additionally, chronic worries result in high levels of corticotropin-releasing factor (which is a hormone and neurotransmitter released in response to stress) and high levels of cortisol, leading to impaired vagal tone.¹⁰ Thus, chronic anxiety not only affects the academic performance of the students but also increases the risk of future cardiac events.

Yoga is a holistic discipline that integrates mind and body practices. It has been observed that yoga-based interventions are beneficial in improving overall mental health disorders.¹¹ It also improves the symptoms specific to anxiety.¹² In students, it has shown a significant effect in improving psychological distress¹³ along with depression and anxiety.¹⁴ It has also been observed that pranayama is very helpful in reducing test anxiety in university students.¹⁵ Along with anxiety and mental health, yoga has a deep impact on regulating the activity of our autonomic nervous system.¹⁶ Yoga can help in HRV modulation, resulting in a significant shift towards the autonomic balance.¹⁷

A systematic review has observed the effect of mindfulness-based interventions like yoga and tai-chi on perceived stress, along with HRV and found that yoga is more effective in managing perceived stress and bringing the Sympathovagal balance.¹⁸

Earlier researchers have also conducted a systematic review to understand the effect of yoga interventions on anxiety levels in adults¹² as well as students¹¹ and HRV¹⁶ separately, but to date, there is no such review that observes the effect of yoga intervention on anxiety levels and HRV together in the student population. This study aims to review the existing literature and find out the effect of yoga on anxiety levels and HRV in the student population. The objective of this systematic review is to evaluate the effect of yogic interventions on students’ autonomic nervous system activity and anxiety levels.

Methodology

Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Guidelines were followed to design and report this review. The protocol of this study was registered at PROSPERO (CRT42025635133).

Eligibility Criteria

Population, Intervention, Control, and Outcomes (PICO elements) were pre-determined to decide the inclusion and exclusion criteria. Studies were included in this review if they: (a) were randomised controlled trials (RCTs) assessing the effect of Yogic Interventions on the HRV and anxiety among student’s population, (b) Included both the variables, that is, HRV and anxiety, and one of them must be primary variable, (c) Included the student population between the age ranging from 15 to 35 and (d) had yoga as an intervention regardless of style, frequency, and duration.

The studies that: (a) do not have Anxiety or HRV as the primary variable, (b) have any other intervention such as Mindfulness meditation (MM), Zen Meditation, or Physical Exercise, (c) were reported in any other language than English or (d) assess different mental outcomes such as depression or PTSD were excluded from this review.

MM, such as Vipassana meditation, mindfulness-based stress reduction, and mindfulness-based cognitive therapy, primarily aim to cultivate non-judgmental awareness and moment-to-moment observation without a spiritual and energetic aim, whereas yogic meditation, such as dhayan, trataka, yoga nidra or Om meditation, is goal-oriented and linked to self-transcendence.¹⁹

Literature Search

Studies were searched on PubMed, Scopus, Web of Science, Cochrane CENTRAL, and Science Direct databases using the keywords: (Yoga [Mesh] OR yoga [tiab] OR asanas [tiab] OR pranayama [tiab] OR ‘yogic breathing’ [tiab] OR meditation [tiab] OR dhyana [tiab] OR dhyan [tiab] OR shatkriya [tiab] OR shatkarma [tiab] OR ‘cleansing technique’ [tiab] OR mudra [tiab] OR bandha [tiab] OR chanting [tiab] OR ‘mantra chanting’ [tiab] OR ‘OM Chanting’ [tiab] OR ‘Nadanusandhan’ [tiab] OR ‘OM’ [tiab] OR MSRT [tiab] OR ‘mind sound resonance technique’ [tiab] OR ‘Cyclic meditation’ [tiab]) AND (‘Randomised controlled’ [tiab] OR ‘Randomised controlled’ [tiab] OR randomised [tiab] OR randomised [tiab] OR control [tiab] OR ‘controlled trial’ [tiab]) AND (‘heart rate variability’ [tiab] OR HRV [tiab] OR ‘cardiovascular autonomic functions’ [tiab] OR ‘cardiac autonomic function’ [tiab]) AND (student [tiab] OR students [tiab] OR ‘university students’ [tiab] OR ‘university student’ [tiab] OR ‘school students’ [tiab] OR ‘college students’ [tiab] OR ‘college student’ [tiab] OR ‘pg students’ [tiab] OR ‘ug students’ [tiab] OR ‘post graduates’ [tiab] OR ‘under graduates’ [tiab] OR learners [tiab] OR ‘young adults’ [tiab] OR ‘sedentary adults’ [tiab] OR adolescent [tiab] OR ‘adolescent student’ [tiab] OR ‘adolescent students’ [tiab] OR young [tiab] OR ‘young student’ [tiab]). This search strategy was initially formulated for PubMed and subsequently adapted for Web of Science, Cochrane CENTRAL, and Science Direct. This full search strategy is provided in Supplementary Material (Table S1). Additional searches for grey literature were done on Google and Google Scholar. A reference list of studies was also screened for more related papers. This search was conducted from 11th January 2025 to 11th February 2025. The search results were subsequently updated on 5th April 2025 to include any newly published studies. The search underwent careful verification to ensure accuracy, comprehensiveness, and reproducibility. After the studies were retrieved from the databases, they were exported to Excel, where duplicates were removed, and titles and abstracts were screened using the set inclusion and exclusion criteria. Passed studies undergo full-text review. The literature search and screening were conducted independently by two reviewers; any conflicts between the reviewers during screening or full-text review will be resolved by consensus or involving the third reviewer, whenever needed. A detailed flow of the selection of the studies is shown in Figure 1.

Figure 1.

Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) Flowchart.

Data Extraction

After reviewing the published relevant research studies, data were extracted in the pre-designed Microsoft Excel sheets by two independent reviewers. The following information was retrieved from each study: First Author, publication year, country, research design, target population, number of groups, total participants, the mean age of participants, participants in each group, type, duration, and frequency of intervention, and control conditions, variables studied, mean and the standard deviation (SD) of all groups along with effect size and whether adverse events are reported. Any conflicts or differences were then resolved via discussion with other authors.

Quality Assessment

For the quality assessment, Cochrane Risk of Bias version 2 (RoB 2) was used, and two reviewers independently assessed the RoB and the quality of the articles. ROB 2 assesses the five potential domains of bias to categorise studies as having high, low, or some concerns in randomisation method, variations from the intended interventions, missing outcome data, measurement of the outcomes, selection of the reported outcomes, and crossover design. One more domain is their bias arising from the period and carryover effects. Each study’s overall RoB was also estimated. Any conflicts between the reviewers during screening or full-text review will be resolved by consensus or involving the third reviewer, whenever needed. The ROB 2 Excel tool was used to create RoB graphs.

Statistical Analysis

Studies that meet the criteria for both anxiety and HRV outcomes were included in the meta-analysis. Data analysis was conducted on the Cochrane RevMan software.²⁰ A random effect model was chosen to account for excepted heterogeneity among studies. The magnitude of heterogeneity was categorised as (a) I² = 0%–24%: low heterogeneity; I² = 25%–49%: moderate heterogeneity; I² = 50%–74%: high heterogeneity; and I² = 75%–100%: considerable heterogeneity.²¹ Post-intervention values for the yoga and control group were taken for the following outcome parameters: anxiety, high frequency, low frequency, RMSSD and SDNN.

Standardised mean difference effect sizes were calculated in RevMan. Most were done by subtracting the mean of the control from the mean of the yoga group and dividing by the pooled SD.

SDM = M_c – M_y/SD

In anxiety and low frequency negative effect size indicates improvement, whereas in the rest of the variables, improvement in a positive effect size. No subgroup analysis and meta-regression were done due to the small number of studies.

Results

The search identified 255 studies from all databases, 51 of which were duplicates. The remaining studies underwent title and abstract screening, and 177 were excluded. Most studies were excluded because they did not have the target population for this review or were not RCTs. 27 Studies were then assessed by reading the full texts. After reviewing the full texts, 22 studies were excluded due to providing interventions other than yoga, such as MM or tai-chi (n = 5), or having a population other than students (n = 1). not assessing anxiety (n = 11) or HRV (n = 1) as a primary variable, or lacking randomisation (n = 2). Five studies met the eligibility criteria and were included for the meta-analysis. The selection process of the studies is shown in Figure 1.

Study Characteristics

The included studies comprise three parallel group RCTs and two crossover designs, encompassing a total of 277 participants with a mean age of 19.25 years. Four studies reported the gender distribution, among these majority (78%) were female participants. One study (Sancinelli,2022) did not report gender distribution. All studies were published between the year 2018 and 2024.

Two studies were conducted in the USA,^{22, 23} and the remaining study was conducted in China,²⁴ Canada,²⁵ and Finland.²⁶

Participants Characteristics

Four out of five studies included graduate and undergraduate students, whereas one study included adolescent school students.²⁴ One study conducted a follow-up assessment after 3 months,²³ and the other four studies included only pre- and post-intervention assessments without any follow-up.

Intervention

All studies have given different types of interventions, like Sudarshan Kriya Yoga (SKY),²³ Vinyasa flow,²² Hath yoga,²⁴ sun salutations along with standing poses,²⁵ and traditional yoga alone, and along with MM.²⁶ The length of the intervention varies from 30 minutes to 4 weeks. Two studies had more than two groups comparing different interventions with yoga. Sancinelli (2022) used the three-group design comparing hath yoga with recreational sports and no intervention.²⁴ Whereas Hunt et al. (2018) included five groups in their study comparing traditional yoga alone with MM, Yoga and MM together, a study break with a therapy dog, and a no-intervention group.²⁶

Assessments

The included studies assessed various psychological, physiological, and subjective measures, with a strong emphasis on anxiety and HRV. Anxiety-related variables included state and trait anxiety,^{22, 25} cognitive test anxiety,²⁵ competitive state anxiety²⁴ and anxious arousal.^{23, 26} Mood disturbances, depressive symptoms, and stress-related constructs were also examined through measures such as the Beck Depression Inventory,^{22, 26} Perceived Stress Scale, and general distress.²³ HRV was assessed across multiple studies using different measures, such as time domain indices, RMSSD^{22, 24, 25} and SDNN^24–26 along with frequency-domain measures such as low frequency and high frequency,^{22, 24, 25} LF/HF^{24, 25} and Total power.²³ Additionally, physiological measures included heart rate (HR)^22–25 and respiration rate,²³ while stress biomarkers such as salivary cortisol and alpha-amylase were analysed in one study.²⁵ Subjective emotional responses to stimuli were evaluated using valence ratings of IAPS images,²² mood assessments via visual analogue scales,²⁵ and measures of social connectedness and self-esteem.^{23, 25} Other assessments included personality traits,²³ cognitive function²⁶ and social identification.²⁵

Key Findings

The reviewed studies collectively highlight the beneficial effects of yoga on anxiety, HRV, and overall well-being. Albert-Schulte ∆ Robert-McComb (2018) found that both yoga and rest significantly reduced state anxiety and improved HRV, though these effects diminished after exposure to emotional stimuli. Goldstein et al. (2020) reported that SKY was more effective than a cognitive-based wellness workshop in enhancing psychological well-being, reducing stress, and improving HR stress reactivity. Hunt et al. (2018) demonstrated that yoga, mindfulness, and their combination effectively reduced anxiety and dysphoria, with yoga and combined interventions leading to the highest HRV at rest. Sancinelli (2022) showed that Hatha yoga significantly increased HRV and improved autonomic function while reducing cognitive and somatic stress. Lastly, Thomson et al. (2024) found that yoga before a simulated exam reduced subjective stress but did not significantly impact physiological markers like HRV or cortisol. Overall, these findings suggest that yoga interventions can effectively reduce anxiety and improve autonomic regulation, though their impact on physiological stress markers may vary depending on context and intervention type.

Meta-analysis

Effect of Yoga on Anxiety

The meta-analysis of anxiety includes four studies that measured 171 students’ anxiety using self-reported questionnaires, shown in Figure 2 pooled results indicate there is consistent evidence that yoga significantly reduces anxiety among the students (SMD = −7.72; 95% CI: −9.54, −5.90). High inconsistency among the studies was reported as the heterogeneity (I² = 92%) was high.

Figure 2.

Forest Plot of Four Studies Included for Meta-analysis. Mean and Standard Deviation Refers to the Anxiety Score in Yoga (Experimental) Group and Control Group in All Studies. Furthermore, the Sample Size Under Each Group Is Presented Under ‘Total’. SD: Standard Deviation, CI: Confidence Interval, IV: Inverse Variance.

Effect of Yoga on High Frequency

The meta-analysis of high frequency (frequency-domain of HRV) was conducted with two studies and 32 students in each group, as shown in Figure 3. Pooled results show that post-intervention yoga was associated with increased frequency, but confidence intervals suggest high variability (SMD = 3.37; 95% CI: −7.21, 13.96). There was significant heterogeneity (I² = 98%).

Figure 3.

Forest Plot of Two Studies Included for Meta-analysis. Mean and Standard Deviation Refers to the HF Value in Yoga (Experimental) Group and Control Group in All Studies. Furthermore, the Sample Size Under Each Group Is Presented Under ‘Total’. SD: Standard Deviation, CI: Confidence Interval, IV: Inverse Variance, HF: High Frequency.

Effect of Yoga on Low Frequency

Low-frequency results were conducted on the two studies, and 32 participants in each group, as shown in Figure 4. The result indicates that there is no consistent evidence that yoga reduces low frequency (SMD = 2.03; 95% CI: −6.98, 11.04), and there is high heterogeneity (I² = 91%) among the two studies.

Figure 4.

Forest Plot of Two Studies Included for Meta-analysis. Mean and Standard Deviation Refers to the LF Value in Yoga (Experimental) Group and Control Group in All Studies. Furthermore, the Sample Size Under Each Group Is Presented Under ‘Total’. SD: Standard Deviation, CI: Confidence Interval, IV: Inverse Variance, LF: Low Frequency.

Effect of Yoga on RMSSD

RMSSD result was obtained on three studies, and a total of 90 students were shown in Figure 5. Pooled results show that post-intervention yoga was associated with significantly increased RMSSD (SMD = 35.76; 95% CI: 30.60, 40.93), but high inconsistency was there (I² = 97%).

Figure 5.

Forest Plot of Two Studies Included for Meta-analysis. Mean and Standard Deviation Refers to the RMSSD Value in Yoga (Experimental) Group and Control Group in All Studies. Furthermore, the Sample Size Under Each Group Is Presented Under ‘Total’. SD: Standard Deviation, CI: Confidence Interval, IV: Inverse Variance, RMSSD: Root Mean of Squared Standard Deviation.

Effect of Yoga on SDNN

SDNN result was obtained on two studies, and a total of 50 students are shown in Figure 6. The result indicates that yoga significantly increases SDNN (SMD = 29.42; 95% CI: 21.24, 37.60), and high heterogeneity was reported (I² = 96%).

Figure 6.

Forest Plot of Two Studies Included for Meta-analysis. Mean and Standard Deviation Refers to the SDNN Value in the Yoga (Experimental) Group and Control Group in All Studies. Furthermore, the Sample Size Under Each Group Is Presented Under ‘Total’. SD: Standard Deviation, CI: Confidence Interval, IV: Inverse Variance, SDNN: Standard Deviation of the Time Between Normal Heartbeats.

Quality Assessment

Two separate risks of bias (Cochrane Risk of Bias for RCT and Cochrane Risk of Bias for crossover design) were used to appropriately evaluate methodological quality in each study design. Among the five RCTs, several were found to have some concerns regarding bias, indicating a high level of risk in methodological quality. There is some concern about randomisation and high risk due to missing data and selective reporting in all the studies, which could impact the reliability of the results. The details of the quality assessment are present in Figures 7 and 8.

Figure 7.

Summary of Risk of Bias Assessment for Randomised Trials.

Figure 8.

Risk of Bias Assessment for Crossover Trials.

Discussion

This systematic review and meta-analysis evaluated the impact of yoga on anxiety and HRV among student populations. A total of five studies involving 277 participants with a mean age of 19.3 ± 1.89 years met the eligibility criteria for the systematic review. However, one study²⁶ was excluded from the meta-analysis as it did not mention the mean and SD required for statistical analysis. The remaining four studies assessed anxiety, while three studies examined the HRV Indices such as RMSSD and SDNN.^{22, 23, 25} Among these, SDNN was evaluated in two studies,^{24, 25} and RMSSD was measured in three studies.^{22, 24, 25} Yoga intervention ranged from a single 30-minute session^{22, 25} to a longer intervention spanning 3–4 weeks.^{23, 24} Most of these studies incorporated dynamic styles of yoga such as SKY, Vinyasa Flow, Hath Yoga, Sun Salutations, along with standing poses and traditional yoga. Although the findings indicate some benefits, the literature highlights those gentle forms of yoga—such as pranayama, simple postures, and relaxation techniques—are more effective in improving HRV measures and reducing anxiety. However, the dynamic forms of yoga used in these studies may have been chosen considering the student population. All studies except one,²² included both males and females. All the studies assess the HRV as the physiological measure of anxiety along with subjective measures among the students, which helps in understanding the true impact of yoga on psychological stress and physiological autonomic regulation in students.

This systematic review and meta-analysis suggest a positive impact of yoga on anxiety and HRV measures among the students. The four studies reported a significant reduction in anxiety among students following yoga interventions, with a large effect size. However, the heterogeneity was high. Consistent with existing meta-analyses, Cramer et al. (2018) report similar effects and another study by Breedvelt et al. (2019) report yoga’s effectiveness on anxiety, but with a moderate effect size.¹¹ However, a 2023 meta-analysis by Kumawat et al. (2023) showed no significant anxiety reduction, suggesting variability in effectiveness by yoga type.²⁷ Three studies showed a significant improvement in autonomic balance, shown by an increase in RMSSD^{22, 24, 25} consistent with the 2024 systematic review by Giridharan et al. (2024),²⁸ which included 23 RCTs from 2015 to 2024, reporting enhanced parasympathetic activity in chronic conditions, and Tyagi and Cohen (2016) in a comprehensive review, noted yoga’s role in improving vagal dominance.¹⁶ Two studies reported a significant increase in SDNN,^{24, 25} supporting yoga’s potential to enhance autonomic balance, aligning with a systematic review with meta-analysis by Zou et al. (2018), which found mind-body exercises like yoga improve HRV parameters.¹⁸ Two studies^{22, 24} showed a non-significant increase in HF and LF, suggesting frequency-domain measures may be less sensitive to yoga’s effects in this population. The high heterogeneity among all the domains of HRV in studies is due to variation in intervention type (e.g., Vinyasa flow, Sudarshan Kriya, Hatha yoga), durations (1 day to 4 weeks). There is also various literature available to indicate yoga improves anxiety and HRV through an integrative multisystem mechanism, modulating neural, autonomic and biochemical pathways via the activation of interoceptive and proprioceptive pathways. Yoga balances the autonomic nervous system and controls both anxiety and HRV by improving the parasympathetic activation, vagal tone and downregulation of sympathetic nervous system.^{16, 29, 30} Simultaneously, yoga enhances the prefrontal cortex (especially ventromedial) activity and suppresses amygdala hyperactivity, which helps in anxiety and restoring emotion regulation, autonomic control.³¹ This neural reconfiguration is complemented by neuroendocrine modulation, as yoga downregulates the hypothalamic-pituitary-adrenal (HPA) axis hyperactivity and reduces stress-induced cortisol secretion via glucocorticoid receptor sensitisation, which helps in managing anxiety and neuroinflammation.³² Biochemically, Yoga influences the neurotransmitters and hormones, helping to restore biochemical balance and reduce anxiety symptoms by increasing Gamma-Aminobutyric Acid (GABA), increasing serotonin, dopamine and brain-derived neurotrophic factor (BDNF).^33–35 For the brief visual mechanism, refer Figure 9. A notable degree of heterogeneity persists among the studies. There are several factors for the heterogeneity. First, the characteristics of the students, such as variation in academic discipline, year of study, baseline anxiety level, and cultural context. Second, the yoga intervention is highly variable, with different styles, durations, frequencies and specific combinations of practice. Additionally, outcome measures used to assess the effect are considered in terms of tools, scales, and timing of the assessments. For more details, refer to Table 1. The heterogeneity may be reduced by conducting rigorous multicentric RCTs with a validated yoga module. The findings of the review have practical implications for promoting students’ well-being. Yoga intervention can be integrated into university wellness programmes and stress management workshops. Implementing such an intervention helps students manage stress, enhance emotional regulation, and potentially improve academic performance. The strengths of this systematic review and meta-analysis is one of its kind to report the effect of yoga on anxiety and HRV among students. The study involves a rigorous search of the database with predefined criteria, screening and data extraction of studies done independently by two authors. There was a robust RoB assessment of all the studies using a standardised tool. However, there were very few studies that matched our inclusion criteria for meta-analysis, which affects the generalizability of our findings. The power of this meta-analysis with fewer studies is low due to limited information, the chances of Type II errors are high, and there is difficulty in estimating effect size. With few studies, estimates of heterogeneity (e.g., I²) can be unstable and less reliable, and the statistical power to detect true heterogeneity is limited. Therefore, the result should be interpreted with caution. Further, because yoga is an intervention taken as a whole, we are unable to identify specific practices that have an impact on anxiety and HRV among students. The intervention duration of the included studies is considerably shorter, varying from 30 minutes to 4 weeks. This limited timeframe may not be enough to assess the beneficial effects of yoga on anxiety and HRV. There has been no deviation from the protocol registered with PROSPERO.

Figure 9.

Possible Underlying Mechanism of How It Can Affect the HRV and Anxiety.

Table 1.

Characteristics of Included Studies.

First Author	Year	Population	Research Design	Intervention	Intervention Period	Outcome of Interest	Sample Size		Mean Age	Female
Albracht-Schulte et al.	2018	Female college students	Two-way crossover randomised control trial	Video taped yogafit vinyasa flow	One day (30 min single session)	STAI; heart rate; RMSSD; LFNU; HFNU	Intervention	40	20.18 ± 1.97 20.18 ± 1.97	40
							Control	40
Goldstein et al.	2020	Undergraduate and graduate students	Randomised control trial	Sudarshan Kriya workshop	Four days	PSS; PSQI; mood and anxiety symptom questionnaire (Distress); MASQ – anxiety; MASQ – depression; MASQ mood disturbance; big five personality inventory (extraversion); BFI – agreeableness; BFI – conscientiousness; BFI – neuroticism; BFI – openness; self-esteem (RSES); satisfaction with life; heart rate; HRV total power	Intervention	37	20.7 ± 3.2 20.7 ± 2.8	50
							Control	32
Sancinelli	2022	5–18 adolescent students	Three-arm randomised controlled trial	Hatha Yoga	Three weeks (three sessions per week) (50 min per session)	SDNN; RMSSD; LF; HF; LH/HF; CSAI – cognitive anxiety; CSAI – somatic anxiety; CSAI – self-confidence	Intervention -hath yoga	12	16 ± 2 all three-group	Not mentioned
							Recreational sport group	12
							Control	12
							Intervention	13		20.1 ± 4.920.1 ± 4.9	10
Thomson et al.	2024	Undergraduate students	Randomised repeated measures crossover	Yoga flow	One day (30 min single session)	STAI; test anxiety; cognitive test anxiety scale; generalised anxiety (GAD-7); VAS anxiety; salivary cortisol; salivary alpha-amylase; RMSSD; SDRR; LF power; HF power; LF:HF	Control	13		20.1 ± 4.9
Hunt et al.	2018	Undergraduate students	Five-arm RCT	Mindfulness meditation	Four weeks (one session per week)	STAI; PANAS; BDI; SDNN	Mindfulness meditation+ yoga	22	19.3 All five groups	88
							Mindfulness meditation	23
							Yoga alone	24
							Dog group	26
							Control	24

Conclusion

The number of randomised clinical trials assessing the efficacy of yoga in anxiety and HRV among students is very low. Although we included five studies reporting the effect of yoga on anxiety and HRV, the pooled effect of studies included in the meta-analysis showed yoga has a positive effect on anxiety and HRV, but high heterogeneity and fewer studies affect the generalizability of the findings. We also found that all studies have high RoB. Future RCTs are recommended to consider a large sample size. robust methodology, practice adherence and integrity in delivery. This can aid in extrapolating the results and even tailoring particular yoga to the demographic of the subgroup.

Footnotes

Authors’ Contribution

Shivam Sharma: Conceptualization, methodology, formal analysis, writing- original draft.

Dewansh Kaushik: Methodology, data curation, writingoriginal draft.

Sarashti Saini: Writing- original draft, visualization. Harish Sharma: Writing- original draft.

Kashinath Metri: Conceptualization, writing- review & editing, supervision.

Data Availability

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Statement of Ethics

Not applicable for the study.

Supplemental Material

ORCID iD

Kashinath Metri

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